The case for school nurses

In 1897, New York City hired 150 physicians to inspect the hundreds of thousands of students — many of them recent immigrants — packed into its public schools. Authorities were especially worried about children with tuberculosis, who were removed from the classroom and sent home with a note.

There was only one problem: Many of the students' parents couldn't read English. Nor could they afford the medicines and other treatments the school doctors recommended.

So the nurse and social reformer Lillian Wald came up with a better idea: Instead of sending sick kids home, why not treat them at school?

And so school nursing was born. In the fall of 1902, Wald provided nurses from her Henry Street Settlement to four large New York high schools, where they tended to 10,000 students. At one school, radiators and window sills doubled as examination tables; at another, children sat in a secondhand high chair to get their eyes checked.

I thought of Wald as I read the recent news about the Philadelphia School District, where the layoffs of 47 nurses became effective just before Christmas. With that and an earlier round of cuts, the city's force of school nurses has been reduced by more than a third since last year. It's now down to 185 nurses, who will have to split their time among 367 schools.

The cuts reflect a disturbing national trend. Only 45 percent of American public schools now have a full-time nurse. Thirty percent have a nurse who works part time, which is the case in most Philadelphia schools, and fully one-quarter have no nurse at all.

Growing needs

Meanwhile, America's children face a growing litany of health problems. According to the National Center for Education Statistics, chronic and acute illnesses — including asthma, epilepsy, and diabetes — have spiked 60 percent among students over the past two decades. The incidence of childhood diabetes has doubled in the last 10 years alone.

Who treats these sick kids? Frequently, it's the school nurse. Here in Philadelphia, roughly 26,000 children still lack health insurance. A visit to the school nurse often prevents a much more expensive trip to an emergency room, where the uninsured still receive much of their health care.

Nurses also help prevent childhood illnesses from developing in the first place. The rapid increase in diabetes is strongly related to obesity, which now afflicts almost one in five school-age American children. Nurses can teach better nutrition, exercise, and other habits that keep kids healthy.

Last but not least, school nurses help keep children in school. A recent study by the Journal of School Nursing found that only 5 percent of children who got sick at school were sent home after being evaluated by a nurse. When a staff member other than a nurse dealt with sick children, by contrast, 18 percent were sent home.

Heartless blindness

That brings us back to Lillian Wald, whose four-school experiment was so successful that New York officials expanded it citywide. By hiring 25 nurses, the public schools reduced the number of students sent home from roughly 10,000 in 1902 to a little more than 1,000 in 1903 - an astounding decrease of 90 percent. School nurses also made home visits to children who were removed from school, treating their illnesses and instructing their families in hygiene and prevention.

Other cities quickly followed New York's example. Los Angeles put nurses in its schools in 1904, Boston did so the following year, and Philadelphia hired its first school nurses three years after that, in 1908.

Over the ensuing century, school nurses provided a variety of crucial health services. As public vaccination expanded, nurses helped ensure that children were protected against polio, diphtheria, and other diseases. And when the federal government required schools to accommodate handicapped children, including those who needed catheterizations and feeding tubes, their care often fell to - you guessed it - school nurses.

Today we're told that nurses are too expensive for cash-strapped school districts. But the same objection was raised back in Wald's time, at the dawn of school nursing. "There are still many people, even kindly souls, who cry out about this 'fad' because of the cost," wrote Lina Rogers, New York's first full-time school nurse. "What willful, heartless blindness."

She was right. A hundred years later, let's hope kindly Americans will open their hearts — and their wallets — to school nursing. The alternative is to close our eyes, like little children, and pretend nobody can see.

That's History is a biweekly radio segment co-produced by the Historical Society of Pennsylvania and WHYY featuring HSP historian Jonathan Zimmerman. That's History will take an event, issue or person in the news, and look back into history for echoes, parallels, roots and lessons.

Here in Philadelphia, roughly 26,000 children still lack health insurance. A visit to the school nurse often prevents a much more expensive trip to an emergency room, where the uninsured still receive much of their health care.

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